Gluttony and Sloth

It is easy, right? Eat less and move more and you will lose that extra body fat that slowly accumulated over the previous few decades. Is this true or is the “eat less move more” mantra spewed by powerful food companies (Big Food) who push delicious addictive ultra-processed junk shifting the blame to you because of lack of self-control? Big pharmaceutical companies (Big Pharma) readily hop on this bandwagon because they have thousands of expensive drugs waiting to treat numerous symptoms of chronic disease. If only you had more willpower—you may be surprised that indeed you are not at fault.

Understanding a little history is relevant currently. A technique for measuring the energy of food became widely utilized after W.O. Atwater perfected the bomb calorimeter at the United States Department of Agriculture (USDA) in 1896 (1,2). Food is placed in a pressurized oxygen container, sealed, and surrounded by water, immersed in a steel container. Once food is completely combusted to carbon dioxide (C02) it causes the surrounding water temperature to rise. One large calorie, or kilocalorie (kcal), is the amount of heat needed to raise the temperature of one kilogram of water by one degree Celsius. The International System of Units (SI) is worldwide, the accepted measure of food energy since 1960, although kcal is still widely used in the USA (1). The conversion factors for joules and calories are: 1 kJ = 0.239 kcal; and 1 kcal = 4.184 kJ (1).

So, to simplify the physics and chemistry of thermodynamics the following values are applied to the three major food macronutrients when combusted in a bomb calorimeter:

  • Carbohydrate 17kJ/g (4 kcal/g)
  • Protein             17kJ/g (4 kcal/g)
  • Fat                     37kJ/g (9 kcal/g)

Although not a nutrient per se, Atwater also calculated the value of the heat of combustion of alcohol.

  • Alcohol            29 kJ/g (7 kcal/g)

Because scientists now had something to measure this led to the “Calories-in Calories Out (CICO)” model around 1920 and “calories in” was equated with eating while “calories out” was thought of as exercise. So launched the dictum of losing weight was as simple as eating less and moving more. The elephant in the room not mentioned is the human body is not like a bomb calorimeter. We do not absorb all the calories we eat; different macronutrients markedly affect hormones and our gut microbiome in contrasting ways, nervous system signals affect our appetite and satiety levels in the brain, and more energy is required to metabolize proteins than carbohydrates — to name but a few. There is no question that if more calories stay in the body than are expended this will lead to weight gain, but this is not a useful statement to anyone hoping to improve metabolic health. In similar fashion if my vehicles were two feet longer than most garages — telling me that I need to lengthen the garage, take down walls, as the only solution — without recognizing that more practical advice might be to get a shorter car, is doomed to failure if I cannot get permits for renovations. A century later it is obvious that vehicles might be too long to fit into millions of garages but “it is our fault” because we have not secured the appropriate permission. Just like its your fault for not ‘eating less and moving more’ when failure comes with ‘dieting and exercise.’

Elephant in the room

Why is the CICO model a gift to Big Food and Big Pharma? If you gain a little weight, visit your physician, and are told to lose a few kilograms or pounds, the advice will be, as noted above — eat less (starvation) and move more (exercise). Sadly, a meta-analysis, including twenty-nine studies, revealed greater than 50% of lost weight regained by two years and 80% by year five (3) — and this was in people who remained in weight loss programs for over a year. I suspect much lower success in patients who get frustrated and drop out of one of the many expensive weight reduction programs. Because most of us mere mortals will fail the “standard of care weight loss advice” from health care workers, Big Food and Big Pharma can blame us for our sloth and gluttony. All the ultra-processed garbage (‘food’), all labelled with bar codes, makes these companies trillions of dollars yearly. It may surprise you that since the year 2000 Americans have eaten less yet exercised more —so, the CICO, recently renamed the ‘Energy Balance Model (EBM), would predict we all lost weight over the last 2 decades. Reality check — ‘from 1999 –2000 through 2017 –March 2020, US obesity prevalence increased from 30.5% to 41.9%. During the same time, the prevalence of severe obesity increased from 4.7% to 9.2%.’ (4).

The competing model for ‘why we are getting fatter’ is the carbohydrate-insulin model (CIM). Although much more complex this is the underlying principle; refined grains, added sugars and easily digestible carbohydrates allow rapid glucose absorption from our gut after meals quickly raising our blood glucose levels. Because the human body, containing on average 5 litres of blood, was not designed to handle greater than one teaspoon (approximately 5 grams) of blood glucose the pancreas secretes insulin to drive glucose into storage, as glycogen in muscle and liver, and triglycerides (fat) in adipose tissue (fat cells). This powerful action of insulin negates some of the damage to vital organs and blood vessel linings which otherwise occur. Herein lies the problem — when we eat frequently, products containing easily digestible carbohydrates, added sugars and refined grains our insulin levels stay elevated for hours, eventually becoming chronically elevated over years. Insulin has a powerful ability to prevent the release of fatty acids (fat) from your fat cells. The two fuel sources utilized to make energy in a special part of your cells, the mitochondria, can use either fat or glucose. Because insulin is driving glucose into cells to minimize toxicity and fat cannot get out of the fat cells your brain senses this and thinks you are ‘starving’. It ramps up your appetite, at subconscious complex levels, and you eat more. Should you be one of those rare people capable of tolerating this starvation mode your brain says — OK dude I am going slow down your metabolism, drop your body temperature, decrease your ability to exercise and convert you into, what many of us have experienced with dieting — hungry, cold, tired, cranky, inactive people — all out of your control!

Do you need to understand the science between competing models of why we cannot lose weight? Probably not unless science is an area of interest to you.

Elephant in the room_NHANES

BOTTOM LINE WHAT CAN I DO TO IMPROVE MY METABOLIC HEALTH

Because most of the population is insulin resistant (IR) — unable to handle refined grains, added sugars and easily digestible carbohydrates (5), you might consider the following approach:

  1. Shorten your eating window*. Referred to as time-restricted eating or intermittent fasting this is one of the fastest and most powerful ways to start your journey towards better health. If you eat breakfast at 6:00 am, lunch at noon and finish dinner at 6:00pm there is a 12-hour window when you are not eating. This allows insulin levels to decrease overnight allowing you to access your fat stores. Therefore, if you skip breakfast or dinner, by eating two meals a day (2MAD) then the body has a greater chance to burn more of your stored fat energy. For example, if you eat your first meal at 11:00am and then your second meal at 6:00pm there is a 17-hour window when you are not eating. *Diabetics on insulin and other diabetic and blood pressure meds should work in conjunction with their primary care physician because blood glucose levels and blood pressure may decrease as your body becomes more sensitive to smaller levels of insulin over time.

 

  1. Reduce refined grains, added sugars and easily digestible carbohydrates — start out slowly. The quickest way to remove added sugars and minimize insulin and blood glucose spikes is to stop drinking your calories. Orange juice contains more glucose than soda — eat an orange instead of orange juice. Avoid sodas, juices, or any drink with sugar — consider drinking water instead.

 

  1. Avoid refined grains — white bread, pasta, cereals.

 

  1. If you love veggies try and eat above ground vegetables like spinach, kale, collard greens, broccoli, cauliflower etc.

 

  1. Eat adequate amounts of protein. Why? This gives us satiety (we are not hungry) and success always comes with lack of hunger.

 

  1. Exercise, like walking or gardening, or whatever brings you joy will come naturally as you feel more energized. You cannot out-exercise a bad diet because your brain is too smart to let that happen.

 

For additional valuable free information of the web, I recommend dietdoctor.com. This valuable resource gives you ideas on how to improve your metabolic health, regardless of diets spanning vegan-vegetarian-carnivore. Everyone can look and feel better. My intent is never to tell anyone what they should eat or if they should exercise. Should you be interested in your own healthspan and quality of life then you may wish to research more on this topic. Of interest if your reduce your insulin resistance, lower your fasting blood glucose and fasting insulin level, and avoid large spikes in your blood glucose you fare much better should you become infected with SARS-CoV-2 (COVID-19) — COVID-and-Metabolic-Health-with-notes.pdf (hotg.ca)

 

 

  1. Tontisirin, K et al. Food energy – methods of analysis and conversion factors. Issue 77. Food and Agriculture Organization of the United Nations. Dec 2002. Accessed 4 Aug 2022. Available at: pdf (fao.org)
  2. DDS Calorimeters. How do calorimeters work? Digital Data Systems. Accessed 4 Aug 2022. Available at: How does a bomb calorimeter work? (ddscalorimeters.com)
  3. Hall KD, Kahan S. Maintenance of Lost Weight, and Long-Term Management of Obesity. Med Clin North Am. 2018 Jan;102(1):183-197. doi: 10.1016/j.mcna.2017.08.012. PMID: 29156185; PMCID: PMC5764193
  4. Stierman, B et al. National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files Development of Files and Prevalence Estimates for Selected Health Outcomes. National Center for Health Statistics (U.S. 06/14/2021. Series: NHSR No. 158

https://stacks.cdc.gov/view/cdc/106273

  1. Ludwig, DS, et al. Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models. Eur J Clin Nutr. 2022 Jul 28. doi: 10.1038/s41430-022-01179-2. Epub ahead of print. PMID: 35896818